SO MUCH FOR THAT

The American health-care system decimates the emotions and finances of one well-meaning citizen in the latest novel by the provocative Shriver (The Post-Birthday World, 2007, etc.).

We open with a bank-account figure: $731,778.56, which is how much 50-something Shep Knacker has squirreled away for retirement. That’s a decent nest egg for a professional handyman like him, but he wants to make his savings let him live like a prince. To that end, he plans to move his family to Pemba, a tiny island off the coast of Zanzibar where his dollars will go much farther. But his wife, Glynis, is diagnosed with cancer, and the novel’s grimly punning title encapsulates what follows: During the course of a year, Shep is forced to abandon his dream as Glynis’ aggressive treatments drains his savings. Shriver is captivatingly, unflinchingly expert at exposing how families intuit and sometimes manipulate each other’s personality tics, and the novel is at its finest when it shows the parrying between the put-upon Shep and Glynis, who remains a harridan even as her body is ravaged. It’s shakier as a polemic against a health-care system that bankrupts families. Shriver embeds the outrage in Shep’s friend and co-worker Jackson, who delivers jeremiads on how government and health-care corporations connive against the common man. (The book is mostly set in 2005, before Congress’ healthcare reform efforts.) Metaphorically overstating the point that institutional greed affects individual vitality, the book also chronicles Jackson’s botched penis-enlargement surgery, and that’s just part of the piling-on: It also tracks the miseries of Jackson’s ailing teenage daughter and Shep’s rapidly declining father. Yet while this sometimes feels like an op-ed writ large, Shriver’s skill at characterization is so solid that Jackson never becomes a plot device. And the ingenious, upbeat ending smartly shows just how far the rat race separates us from our better selves.

An overly schematic but powerful study of both marriage and medical care.